Cost-effective reduction of neuromuscular-blocking drug expenditures

BACKGROUND: Anesthetic drug expenditures have been a focus of cost-containment efforts. The aim of this study was to determine whether expenditures for neuromuscular-blocking agents could be reduced without compromising outcome, and to determine whether such a cost-effective pattern of neuromuscular blocker use could be sustained. METHODS: Education, practice guidelines, and paperwork barriers were used to persuade anesthesiologists to substitute low-cost neuromuscular-blocking drugs (pancuronium or a metocurine-pancuronium combination) for a more costly neuromuscular-blocking drug (vecuronium). Neuromuscular-blocking drug use in all patients during a historical control period (6 months; n = 4,804) was compared with that during two consecutive 1-yr periods of intervention (n = 9,761/n = 10,695). Expenditures for vecuronium and for all neuromuscular-blocking drugs were compared for the control and intervention periods. The rate of complications related to neuromuscular-blocking drugs was determined by an ongoing continuous quality improvement program. RESULTS: Vecuronium use decreased by 76% during the first and second yr of intervention, compared with the historical period (P < 0.01). The cost of neuromuscular-blocking drugs decreased by 31% (P < 0.01) and 47% (P < 0.01) for the first and second yr, respectively. The complication rate related to neuromuscular-blocking drugs was 0.081% in the historical period and 0.11% and 0.093% during the intervention periods (P = 0.29 and 0.41). CONCLUSION: Practice guidelines, education, and paperwork barriers used together substantially reduced the expenditures for neuromuscular-blocking drugs for 2 yr without adversely affecting clinical outcome.     

Use of the microculture kinetic assay of apoptosis to determine chemosensitivities of leukemias

Chemotherapeutic agents exert their antitumor effects by inducing apoptosis. The microculture kinetic (MiCK) assay provides an automated, continuous means of monitoring apoptosis in a cell population. We used the MiCK assay to determine the chemosensitivities of the human promyelocytic HL-60 and lymphoblastic CEM cell lines and leukemia cells freshly isolated from patients with acute nonlymphocytic (ANLL) or acute lymphocytic (ALL) leukemias. Continuous monitoring of apoptosis in the MiCK assay permits determination of the time to the maximum apoptosis (Tm) and its two components which are initiation time (Ti) and development time (Td). Duration of the three timing components of apoptosis varies from hours to days depending on the drug, drug concentration, and type of target cells. In the MiCK assay, the extent of apoptosis is reported in kinetic units of apoptosis. Kinetic units are determined by the slope of the curve created when optical density caused by cell blebbing is plotted as a function of time. Using the leukemia cell lines, we define the relationship between kinetic units determined by the MiCK assay and the percentage of morphologically apoptotic cells in the culture. Flow cytometry analysis of apoptosis in Annexin-V-fluorescein isothiocyanate-labeled preparations of HL-60 and CEM cells was also used to compare with data obtained by the MiCK assay. The feasibility of the MiCK assay of apoptosis as a chemosensitivity test was confirmed by its comparison with a 3H-thymidine incorporation assay. We show that samples from 10 ANLL and ALL patients patients tested for sensitivity to various doses of idarubicin (IDR), daunorubicin (DNR), or mitoxantrone (MTA) gave the same percentages of apoptotic cells when calculated by the MiCK assay as when determined by morphological analysis. The MiCK assay was used for dose-response analyses of the sensitivities to IDR, DNR, and MTA of leukemia cells from 4 other patients (2 ANLL and 2 ALL). The results from both cell lines and patient samples indicate that ANLL cells are more sensitive than ALL cells to all three of these chemotherapeutic agents. However, for individual patients the chemosensitivities varied significantly among the three chemotherapeutic agents. These varying responses to IDR, DNR, and MTA indicate that the MiCK assay results can be of potential use in designing a treatment regimen for a specific patient with acute leukemia. Among several drugs of presumed similar efficacy, the MiCK assay can permit the selection of the specific chemotherapeutic agent that causes the most apoptosis in the patient's leukemic cells.     

Randomised trial comparing the upright and supine positions for the second stage of labour

OBJECTIVE: To assess the maternal and neonatal effects of upright compared with recumbent positions during delivery, in terms of defined outcome variables. DESIGN: A randomised controlled trial. SETTING: St Monica's Nursing Home, a midwife based maternity unit in Cape Town, South Africa. PARTICIPANTS: Five hundred and seventeen women of low obstetrical risk assigned to deliver at the nursing home. RESULTS: The trial showed that women who adopted the upright posture for delivery experienced less pain. perineal trauma and fewer episiotomies than those who delivered in the supine position. CONCLUSION: The data suggest that in women of low obstetrical risk, choice of posture during delivery may be encouraged.     

Postpartum haemorrhage in Zimbabwe: a risk factor analysis

OBJECTIVES: To identify risk factors associated with postpartum haemorrhage (PPH) in order to improve the effectiveness of antenatal screening. DESIGN: A population-based case control study. SETTING: Harare, Zimbabwe. SUBJECTS: Two groups of women, one group consisting of those with postpartum haemorrhage after a normal vaginal delivery and the other of women with normal unassisted vaginal delivery without PPH. METHOD: Data abstracted from the medical records; relative risks were estimated by multivariate logistic regression. RESULTS: Low parity, advanced maternal age, and antenatal hospitalisation were among the strongest risk factors, with more modest associations for history of poor maternal or perinatal outcomes and borderline anaemia at the time of booking. No association with grand multiparity was found. CONCLUSIONS: These findings confirm the importance of previously recognised factors such as low parity, poor obstetric history, anaemia, and prolonged labour, but call into question the significance of grand multiparity. Previously undocumented factors such as maternal age greater than 35 years and occiput posterior head position emerged as predictors worthy of further investigation.     

Dynamics of drying and flooding of rod assemblies in vessel reactors with a small leak

Scientific and Industrial Association TSKTIOKBM. Translated from Atomnaya énergiya, Vol. 80, No. 2, pp. 76–81, February, 1996.     

Sulpiride in the prophylactic treatment of migraine

The aim of the work was investigation of both efficacy of sulpiride, atypical neuroleptic drug with pronounced antidepressive activity, and its influence on central nervous system. The study was performed in the course of prophylactic treatment of migraine using contingent negative variation (CNV) index. It is demonstrated that sulpiride is effective in prophylactic treatment of migraine complicated with psychologic disorders and autonomic dysfunctions. Such effect may be caused by the drug's influence on depression, anxiety, autonomic symptoms, tension-type headaches. This conclusion was confirmed by CNV data, change of which after sulpiride administration have indicated normalization of mental performance and increase of active adaptive abilities.     

Neurodevelopmental outcome at age two years amongst very low birth weight infants: results from a district general hospital

SCOPE OF THE STUDY: We studied the possibility to examine position and determination of IOL and capsular bag supporting ring. PATIENTS AND METHODS: We showed in ten human eyes the identification of capsular bag supporting ring (PMMA, 12,5 mm open diameter) and intraocular lenses (IOL, 13,5 mm diameter) and haptics by ultrasound biomicroscopy in radar and limbus parallel scans 12 to 18 months post operation. RESULTS: Both alloplastic implantates show typical sceems of reflection and could be differentiated by ultrasoundbiomicroscopy. In eyes with zonulolysis up to 6 hours a good centration of capsular bag supporting ring and IOL had been seen, with more zonulolyses a slight subluxation could been shown. CONCLUSION: Ultrasound biomicroscopy is a good method to determine the position of intraocular lens and capsular bag supporting ring.